Cancer patients in Gauteng die while waiting for radiation treatment. And the delays mean any intervention already made is rendered useless.
"It's bigger than the Esidimeni tragedy," said one senior oncologist.
About half of all cancer patients will need radiation as part of their treatment, but can expect to wait up to four months if they are accessing it in state hospitals in Johannesburg and Pretoria - delays described by doctors as "extreme and unacceptable".
Waiting too long for radiation can mean the cancer is much more likely to return, explained the medical director at Campaigning for Cancer, oncologist Devan Moodley.In December a surgeon at Steve Biko Academic Hospital in Pretoria wrote to the hospital manager to ask that the radiation backlog be dealt with.
In the letter, seen by the Sunday Times, he writes: "Many [patients] have transport problems and cannot visit again and again. Some die waiting for treatment."
In the letter the doctor describes the impact of the backlog, like the patient in his 20s who had a tumour removed in December. He needed to start radiation within six weeks to try to prevent a recurrence of the disease, but his first appointment with the radiology department was in March and he will likely only start radiation in June.
Another patient is described as young and with an "excellent prognosis" - if he receives radiation within six weeks.
"We are wasting scarce theatre time and precious funds by doing sophisticated surgery [to remove tumours], occupying scarce ICU beds post-operation and then not completing the therapeutic programme by omitting radiotherapy," the letter continues.
It says there are not enough radiation machines, a situation exacerbated by maintenance problems, shortages of physicists to maintain the machines and radiation therapists, and no funds to pay overtime.
In 2016, machines at Steve Biko were out of service for a few months, leading to a waiting list for radiation that continued until last month. The hospital is, however, getting new radiation equipment, senior sources said. A doctor who spoke on condition of anonymity said the situation was beginning to improve.
But the director of Campaigning for Cancer, Lauren Pretorius, said radiation delays in Gauteng "were systemic and have been ongoing since 2012".
She said because patients often just went home to die and didn't enter the health system, it was hard to create a proper record of the numbers who weren't getting treated.
By this time last year, every state oncologist in Durban had quit their job over broken radiation equipment at Addington Hospital. A year later, the equipment is still broken, according to Mary de Haas, a member of the Medical Rights Advocacy Network.There is only one full-time oncologist working for the KwaZulu-Natal government in Pietermaritzburg, so desperate patients are seeking treatment in Gauteng.
But they face problems accessing timeous radiation treatment at Charlotte Maxeke Johannesburg Academic Hospital, where there are only two full-time radiation oncologists - and five vacancies for similar posts, two sources confirmed.
The head of medical oncology at the University of the Witwatersrand's faculty of health sciences, Professor Paul Ruff, said chemotherapy was working adequately at both Charlotte Maxeke and Steve Biko.
"In contrast, there are delays in accessing radiation oncology due to outdated radiation machines, which often break down. The current machines at Charlotte Maxeke are 12 to 16 years old."
No provision for new radiation equipment for Charlotte Maxeke has been made in the budget for the next three years, said Pretorius.
Ruff said there were not enough specialists in Johannesburg. "Medical staff shortages are getting worse due to lack of appointments of new radiation oncologists and retirement of older radiation oncologists."
There is also a freeze on hiring staff for the Gauteng health department.
Activist and 10-year cancer survivor David Mfeka said improving cancer treatment needed "political will". "The worst is if the machine is broken, they send you back [home] without a date and you are now fighting the disease, anxiety and depression."
The Gauteng health department has yet to respond.
CROWD-FUNDING TO BEAT DISEASE'S TICKING TIMEBOMB
Desperate to receive radiation after breast cancer surgery, a Johannesburg woman resorted to crowd-funding to pay for the treatment at a private hospital after endless delays at a government facility.
CJ Carrington, who works for a start-up NGO involved in rhino conservation, said she had timeous surgery and received wonderful help from oncologist Dr Carol Benn, who she described "as fighting the entire [state] system".
After Carrington's mastectomy in February last year at Charlotte Maxeke Johannesburg Hospital "I was told I needed radiation within 21 days because the cancer had spread to my lymph nodes".
But "appointment after appointment, you go there and the machine is not ready or they send you back home". Not even a meeting with the head of department resulted in the radiation therapy beginning.
Carrington resorted to crowd-funding to pay for private treatment, and received her radiation in July after raising more than R50,000...